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General NPI Number Information
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NPI Number | 1174056048
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Entity Type | Organization
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Legal Business Name | 141 DENTAL STUDIO PC
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Dates
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Enumeration Date | 04/07/2017
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Last Update Date | 04/11/2017
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Provider Practice Location Address
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Address Line | 141 E 55TH ST SUITE 2B
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City | NEW YORK
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State | NY
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Zip | 10022-4030
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Country | US
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Telephone | 212-262-2952
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Fax |
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Provider Business Mailing Address
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Address Line | 141 E 55TH ST SUITE 2B
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City | NEW YORK
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State | NY
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Zip | 10022-4030
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Country | US
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Telephone | 212-262-2952
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ANGELA ABERNATHY
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Credential |
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Telephone | 212-262-2952
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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